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Menstrual Migraines May Be Preventable

Current Migraine Drugs Work for Headaches With Monthly Periods

WebMD Health News

April 3, 2003 (Honolulu) -- For millions of American women, monthly menstrual periods do not just bring cramps and bloating. They also can suffer the severe throbbing pain, nausea, and sensitivity to light and sound that characterize menstrual migraine headaches .

But now that could all change. For the first time, results from several large, national studies show that a class of drugs known as triptans can prevent menstrual migraines in as many as half of women who take the medications.

In the United States, approximately 9 million women suffer from migraines and about 60% of them report an increased number of headaches in association with their menstrual periods.

These menstrual migraines, which are thought to be triggered by the drop in estrogen levels that accompany monthly periods, typically begin between two days before and one day after the start of a woman's period, according to Stephen Silberstein, MD, director of the Jefferson Headache Center at Thomas Jefferson University Hospital in Philadelphia.

Silberstein led a three-month study of the triptan known as Frova (frovatriptan), enrolling 545 women who had suffered from menstrual migraine headaches for an average of 12 years.

Starting two days before their period and continuing for six days, the patients were given either placebo, a 2.5 milligram dose of Frova or a 5 milligram dose of the drug.

The study showed that headaches disappeared in half of patients treated with the higher dose of Frova. In addition, headaches stopped in over a third of patients taking the lower dose, compared with about one-fourth taking placebo.

Side effects including nausea, dizziness, headache, and fatigue were similar in patients taking the drug and those on placebo.

The study, sponsored in part by Elan, maker of Frova, was presented here at American Academy of Neurology 55th annual meeting.

"Frovatriptan is already approved by the U.S. Food and Drug Administration for the treatment of acute migraines, so women can start taking it immediately," Silberstein said. "Any woman who suffers from menstrually associated migraines should ask her doctor about the medication," he said.

Triptans are a relatively new class of designer drugs that work directly to turn off migraines, according to Silberstein. The medications pack a triple whammy against the headaches: They reduce inflammation of certain blood vessels in the brain thought to cause pain; they block the release of irritating chemicals in the nerve endings; and they prevent transmission of pain signals from the lining of the brain to the brain itself, he said.

Frova isn't the only triptan showing promise for the treatment of menstrual migraines. In a second trial presented at the meeting, Robert Nett, MD, medical director of Texas Headache Associates in San Antonio, looked at another triptan drug - Imitrex (sumatriptan) - in preventing the throbbing headaches.

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